| Sumario: | Background: Adolescents and youth (AY) in the Democratic Republic of Congo (DRC) face significant sexual and reproductive health (SRH) challenges and require access to quality health services. Objective: This study assesses the feasibility, acceptability, and effectiveness of a package of interventions to improve the performance of health workers (HWs) providing SRH services to AY in the DRC. Methods: This mixed-methods process and outcome evaluation was conducted between January and July 2021 in 30 health facilities in Mbuji-Mayi and Kinshasa. Data were collected through interviews with 25 health facility managers, surveys of 54 HWs, focus groups with 29 HWs, and interviews with 16 AY mystery clients and 18 female AY (10–24 years) health facility service users. Qualitative and quantitative data were analyzed using thematic content analysis and descriptive statistics respectively. Results: Health facility managers reported that the package of interventions was feasible to implement, with concerns about resource shortcomings which were outside the scope of the implementation. From both quantitative and qualitative findings, health facility managers and HWs perceived the package of interventions as acceptable and effective in improving HW competencies, building positive attitudes towards providing SRH services to AY, building HW motivation, and fostering an enabling work environment as illustrated by improved communication, mentorship and constructive feedback between managers and HWs, and motivation, confidence and collaboration among HWs. AY clients reported overall satisfaction with the services they received, but some reported experiencing inappropriate comments and judgmental attitudes. Conclusions: The package of interventions was perceived as feasible and acceptable by health facility managers and HWs, and effective in improving HW knowledge, skills, attitudes and motivation, and ultimately in providing SRH services to AY. Future efforts are needed to validate the findings in different contexts and with other professionals, e.g. teachers, and to strengthen and amplify the package of interventions. Paper Context: Main findings: The findings indicate that the health facility managers, health workers and AY reported that the package of interventions was feasible to implement, with concerns about shortcomings in terms of resources which were not intended to be included in the implementation, as well as acceptable and effective in improving health worker performance to provide quality SRH services to AY. Added knowledge: This study found that it is still possible to improve health worker performance to provide quality SRH services without providing financial incentives, but with a comprehensive package of interventions including job descriptions, training and refresher training sessions, desk reference tools, supportive supervision and collaborative learning sessions. Global health impact for policy and action: We expect that the insights from our study on enhancing the competencies and attitudes of health workers, as well as fostering a supportive physical and social environment, could provide valuable guidance for health programs aimed at improving the knowledge, attitudes, skills, competencies, motivation and performance of health workers to provide quality SRH services for AY.
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